Postoperative epileptiform discharges predict seizure outcomes in pediatric low-grade developmental and epilepsy...

Area of Science:

• Pediatric Neurology
• Epilepsy Surgery
• Neurophysiology

Background:

• Low-grade developmental and epilepsy-associated tumors (LEATs) are a significant cause of pediatric epilepsy.
• Epilepsy surgery is a common treatment for drug-resistant epilepsy in children with LEATs.
• Predicting seizure outcomes after surgery is essential for patient management.

Purpose of the Study:

• To evaluate the prognostic significance of interictal epileptiform discharges (iEDs) detected on postoperative video-electroencephalography (EEG) in pediatric patients with LEATs.
• To determine if the presence and evolution of iEDs can predict long-term seizure control after epilepsy surgery for LEATs.

Main Methods:

• A retrospective analysis of prospectively collected pre- and postoperative video-EEG data from 59 pediatric patients with LEATs who underwent epilepsy surgery.
• Assessment of associations between iED characteristics (presence, focus, frequency) and seizure outcomes at least 24 months post-surgery.
• Statistical analyses including univariate and multivariate models to identify independent predictors of unfavorable seizure outcomes.

Main Results:

• A significant increase in iED frequency (≥50%) within the first 12 months post-surgery was independently associated with unfavorable long-term seizure outcomes (OR: 16.2, p=0.037).
• The presence of a secondary iED focus at 3 months and persistent iEDs at 12 months were also associated with unfavorable outcomes in univariate analyses.
• Median postoperative follow-up was 59 months, indicating a robust assessment of long-term outcomes.

Conclusions:

• Postoperative iEDs, especially their temporal evolution, are valuable predictors of long-term seizure outcomes in pediatric LEAT surgery patients.
• Prognostic models for seizure outcomes in LEAT patients should incorporate iED presence and progression from postoperative EEGs, alongside clinical, radiological, and surgical factors.